The Benefits of a Transdisciplinary Trach Team in Inpatient Rehabilitation

Research Objectives: Investigation of benefits of a transdisciplinary trach team in an inpatient rehabilitation environment via exploratory research design focusing on knowledge translation and enhanced patient experience.

Design: Following establishment of a transdisciplinary trach team, including representatives from nursing, respiratory care and speech therapy, we developed a qualitative study to track outcomes. Targeted diet progression via IDDSI and trach size/type, speaking valve trials, capping trials and decannulation.

Setting: Inpatient rehabilitation hospital

Participants: Patients admitted with tracheostomy

Interventions: Holding twice weekly walking rounds, at patient bedside. Discussions during rounds resulting in changes to patient status are reflected on in room signage as well as charted in the medical record.

Main Outcome Measures: The apriori hypothesis of this study was the transdisciplinary trach team leads to increased communication between team members and therefore fewer days to diet upgrade and decannulation. A team member tracks number of days each patient remains with a trach, use of speaking valve, and diet progression. The IDDSI scale has strong consensual validity as a measure of the patient’s diet texture.

Results: For this qualitative study, data for first 12 weeks showed:
Participation in average of 3.5 rounds
7 patients (60%) admitted on diets below “regular” diet of IDDSI 7/0 progressed to IDDSI 5/0 or higher
10 patients progressed to decannulation (80%)

Conclusions: The role of the transdisciplinary trach team is cited as beneficial to the tracheostomized patient’s outcomes especially considering the potential for these patients to have complex needs . In this qualitative study, a common theme among the population was advancement of diet and progression toward decannulation. This information was gathered through analysis of data documented in patients’ medical record and tracked via spreadsheet. The data support the hypothesis that a trach team enhances patient outcomes. Considerations for further qualitative investigation include use of PROMs to explore experience of all stakeholders regarding in-person rounds and interviews to determine the individual’s perceptions of the team rounds. Additionally utilizing analysis software to manage our data could only enhance the analysis of our data.

Author(s) Disclosures: none